1801696901 NPI number — SEALY PHYSICAL THERAPY PTP INVESTMENT LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801696901 NPI number — SEALY PHYSICAL THERAPY PTP INVESTMENT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEALY PHYSICAL THERAPY PTP INVESTMENT LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801696901
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
940 S KIMBALL AVE STE 175
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHLAKE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76092-9024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
602 MEYER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEALY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77474-2714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-627-7774
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2025

Additional Information

Authorized Official

Authorized Official Last Name:
RADLEY
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
713-591-2256

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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